This document summarizes various therapeutic methods in medicine, dividing them into non-invasive and invasive categories. Non-invasive methods include mechanical techniques like extracorporeal shock wave lithotripsy and laser lithotripsy for kidney stone removal. Other non-invasive options covered are electrostimulation, magnetic therapy, thermotherapy using heat/light sources, and ionizing radiation therapy. Invasive methods discussed are mechanical/chemical procedures, ultrasound technologies, electric methods, and vital organ support like artificial respiration and heart pumps.

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Basic therapeutic methods in medicine
Juliana Knocikova

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Basic therapeutic methods in medicine
Non-invasive
•Mechanical
•Electrostimulation
•Magnetic
•Thermic
•Light
•Ionizing radiation
Invasive
•Mechanical and chemical
•Ultrasound
•Electric
•Methods of vital organ
support

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-method of disintegration of cocnrements (in kidneys)
by mechanical effect of numerous shock waves (50 –4000)
with frequency 1 – 10 Hz
Efficiency of this methode : 70 – 98%
Risks: pain, bleeding
-based on photoacustic phenomen
-shock waves are generated by short light impulses
of He-Ne laser in duration of 1,5 – 3 ms and transmitted
by optical fibers to the stone
Non-invasive therapeutic methods
1. Mechanical
1. Extracorporal Shock – Wave Lithotripsy
2. Laser Lithotripsy

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• Waves produced outside of the
patient´s body are focused by
crossing the water medium to
the stone (concrement)
• difference between acustic
impedance of the cocnrement
and the surrounding tissue
• rapid start of pressure gradient
(108
Pa) on the border lines –
disintegration of the
stones, fragments are
eliminated by urinary system
Non-invasive therapeutic methods
1. Mechanical
1. Extracorporal Shock – Wave Lithotripsy

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•Source of shock waves (electric,
electromagnetic, laser...,
form (focal or square) - mostly used is
the point electric discharge in the
water medium
•The real source of shock waves is the
condenser (as a source of voltage)
•Scintilation point (located in the
primary focus of rotary ellipsoid)
•Focusing device (acustic lenses)
Non-invasive therapeutic methods
1. Extracorporal Shock – Wave Lithotripsy
1. Mechanical

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Frequency : 0,8 – 1 MHz
Intensity: 0,2 – 0,3 W. cm-2
The surface of treatment head: 1 – 10 cm2
Indications: chronic diseases of
joints, muscles, nerves
Contraindication: therapy of
malignant tumors
Spasmolytic effect
Analgetic – removal of acid metabolic
products
Biostimulant – acceleration of healing
Parameters
Effects
Non-invasive therapeutic
methods
1. Mechanical
3. Ultrasound high frequency massage with heating of the
tissue

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1. Stimulation effect
Non-invasive therapeutic methods
2. Electrostimulation
1. Electroshocks
2. Defibrilation
•used in psychiatry – pacients with schizophrenia, oligophrenia
and other mental diseases
•cause transition blackout, strong muscles conctraction,
attenuation of CNS and „offset“ of the brain
•live saving treatment therapy
•short electric discharge applied to chest
•condenser current with voltage 5 kV, time 5 ms

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1. Stimulation effect
Non-invasive therapeutic methods
2. Electrostimulation
3. Chronaxymetry
electrostimulation of peripheral nerves and muscles using
DC current as a diagnostical test for determination of chronaxy
(the shortest time under which DC current impulse with double
intensity of Rheobase causes AP
Used for appreciation of
efficiency of the
neurosurgery treatment or
in rehabilitation

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1. Stimulation effect
Non-invasive therapeutic methods
2. Electrostimulation
4. Diadynamic currents
• result of rectified AC currents therapy or high
frequency magnetic field
• method is based on impulse changes during
short and long periods
2. Thermal effect
Mostly observed by AC with frequencies over 100 kHz, used for
heating of tissues in thermotheraphy
• effects: heating of tissues, spasmolytic, analgetic,
antioedematous, tonizing - using in rehabilitation

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3. Electrolytic effect
•treatment of skin – sensitivity malfunction, paralyzed muscles
and supplement treatment in many muscle and nerve diseases
•application of anodal DC results fall of pH under 7,36 and thus
reducing the pain feeling – strong analgetic effect
•application of cathode DC results arrise of pH above 7,4 and thus
increase the pain feeling
Non-invasive therapeutic methods
2. Electrostimulation
2. Galvanism
1. Iontophoresis
•method based on the fact that
ions with the same charge are repeled
•drugs are inserted into a body by an effect of
DC (under time of 20 – 30 min.)

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Non-invasive therapeutic methods
3. Magnetic
• magnetotherapy as a therapeutic methode has been recognised recently
• in healthy subjects no or minimal effects, curative effect can not
be proved in all casses, conception of the „dosis“ is problematic
• application of static magnets and electromagnets on the body surface
during 10 – 45 min (5 – 80 mT)
High intensity of MF may lead to spasm of vessels, CNS disorders,
even to exitus
Therapeutic effects:
• hyperaemia
• spasmolytic
• analgetic
• antioedematous
• antiinflammatory
Indications: diseases of joints, muscles, nerves and hypertension

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Non-invasive therapeutic methods
3. Magnetic
• Magnetoelectric effects – electrical voltages induced by magnetical
fields are lower than cell membrane voltages, but they probably affect
the membrane receptors, activating biochemical reactions in cells
Magnetic induction (T)
• Magnetomechanical effects – caused only by high intensities of
magnetic fields, orientation of dia - and para - magnetic substances in
the body is so, that free energy inside MF is minimalized
• Magnetochemical effects – free radicals are created and antioxidant
systems and series of biochemical reactions are activated
Magnetic fields with low frequency – increase of CNS excitability,
decrease blood flow in the vessels with higher diameter - positive
effect of hypertension treatment
Magnetic fields with high frequency – mainly thermic effects, used in
diathermy and for treatment of inflammatory diseases
HB .µ=

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Non-invasive therapeutic methods
4. Thermic
hydrotherapy
• heat can be brought to the body – positive thermotherapy or
taken away – negative thermotherapy
• medical effects: hyperaemia, reflex vasodilatation, spasmolytic
and analgetic effect, myorelaxation
1. Thermotherapeutic methods using conduction of heat
packs, compresses (cold/warm, dry (45 -55°C)/moist, peloid,
paraffin)
2. Thermotherapeutic methods using convection of heat
1. Hydrotherapy
whole - body bath: hypothermic (10 – 34 °C)
izothermic (34 – 36 °C)
hyperthermic (37 – 42°C)

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Non-invasive therapeutic methods
4. Thermic
3. Whirling baths and underwater massage
2. Scottish torrents
4. Sauna
streams of cold and warm water – arise of immunity
hyperthermic with activation of skin receptors and hyperaemia of tissue
effect of hot (80 – 100°C) and dry air and a bath in cold water results
tonising effect
3. Thermotherapeutic methods with application of IR radiation
1. Infrared radiation – warm bath
heating effect

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4. Thermic
Non-invasive therapeutic
methods
2. Infrared lamp
local surface heating of the tissues, used in
stomatology, dermatology
4. Thermotherapeutic methods with applications of high
frequency electric currents, electromagnetic fields, micro –
waves - DIATHERMY
5. Thermotherapeutic applications of ultrasound
• diathermy and micromasage of the tissue, most of the heat is created
on the borderline between fat and muscle tissue, at least between skin
and muscle
• 1/3 of absorbed US is transformed to the heat
• short wave (27 MHz) resistive connection
• ultra short wave (434 MHz) condenser connection
• microwave (2400 MHz) inductive connection
infrared lamp

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5. Light
Non-invasive therapeutic
methods
1. Phototherapy
Heliotherapy – treatment by sun radiation
Therapy with visible light – blue part of the spectrum – therapy
of icterus – yellow coloured skin in newborn babies
2. Photodynamic Therapy
Photosensibiliser given into the body
is activated by visible light and reacts
with oxygen. It results in disorder of
metabolism of the cells, death of cells
and tissues. This therapy does not
affect the DNA.

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5. Light
Non-invasive therapeutic
methods
3. Ultraviolet light therapy
4. Laser radiation therapy
•UV-A (λ = 315 -400nm), UV-B (λ = 280 – 315nm),
UV-C ( 100 - 280nm)
•Source: mercury – discharge lamp
•biological effects: erythema (UV-B), delayed pigmentation witin (48
– 72 hours), production of vitamine D, killing efect on the germs and
bacteries - using for disinfection of surgery rooms (UV-C)
•light amplification by stimulated emission of radiation
•consists of 3 main parts: effective substance, excitation device, optic
resonator
•types: solid/liquid/gas/ semiconductor, continual/pulse, soft/hard

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5. Light
Non-invasive therapeutic
methods
Principle of laser: atom of substance is reaching the excitation due
to the removing of electrones from basic to higher energetic levels.
Laser radiation is produced by massive replacement of electrons
to their basic levels, under amplification by optic resonator
laser therapy
Low power lasers
• soft – lasers with a maximal power of 500 mW
• treatment effect: analgetic, antiinflamatory,
biostimulating
• local application – skin, the lasers with shorter
wavelengths in red part of light spectrum are used
• deep application – muscles, bones,
the lasers with longer wavelengths in IR part of
spectrum are used

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5. Light
Invasive therapeutic methods
High power lasers
Solid YAG laser – used for photocoagulation of
retinal ablation – (emits radiation in green
part of light spectrum, power supply up to 1,5 W)
Excimer laser – for therapy of myopy and
hyperopy. This laser emits ultraviolet
radiation causing photochemical reaction when connecting with eye
and thus leads to elimination of corneal tissue (1 impulse removes
about 0,25 mm of cornea) - works as a „contactless“ scalpel
YAG laser

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6. Ionizing radiation
Non-invasive therapeutic
methods
• Therapy by nuclear (α, β, γ, neutrons) and non-nuclear (X - ray)
radiation
• Principle of effect: direct effect - production of instabile electric
charged particles (cations, anions) in cells or non-direct effect –
creation of reactive radicals because water radiolysis
comparison of stochastic
(non depending on
dosis) and deterministic
(depending on dosis)
effects of ionizing
radiation
Radiation geometry: Fosusing distance (intensity of radiation
decreases with square of the length)

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6. Ionizing radiation
Non-invasive therapeutic
methods
Radioactive sources with low energy (biggest
dosis remains on surface and close under the
surface of the body
• conventional X-ray radiation (electrons with
10 MeV)
• gama radiation from radioactive source
60
CO
• streams of neutrons (deuterons with 50MeV)
Therapy with increasing energy of
radiation (dosis grows with the depth) –
reaches the tumor precisely
• stream of protons (140 MeV)
• stream of П-mesons 953 MeV)
• O2
ions (3,6 GeV)

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1. Mechanical and chemical
widely used in surgery and stomatology (scalpels, tweezers, peans)
Invasive therapeutic methods
1. Rotary and elevator instruments
2. Water scalpel
rotary and elevator instruments used in stomatology
• cutting tissues by water torrent
(isotonic solution NaCl)
• device consists of: pressure pump,
high pressure hose and water engine
• cuts are smooth

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Invasive therapeutic methods
cryo – destruction of the tumor by freezing
for deep freezing of tissues (from 25°C to -190°C) – liquid
nitrogenium is used. Water molecules changes into ice crystals and
these may harm the cells during rewarming.
Adventage: anestetic effect of cold, small destruction of
the tissue in cut´s surrounding, no bleeding
Using: opthalmology, gynecology, urology, oncolgy
3. Cryocauthery instruments
1. Mechanical and chemical

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Invasive therapeutic methods
• ultasound (US) with high intensity (50 – 1000 W/cm2)
• selective destruction of tissues
High frequency focusing US
(1 – 3 MHz)
Low frequency US (20 – 50 kHz)
Device – ultrasound is produced in
piezoelectric transformer and conducted
by special wave – conducting system,
whitch amlifies its amplitude by 10 times.
Steel scalpel oscitates in resonance with
transformator´s frequency
Widely used in otolaryngology and
neurosurgery.
2. Ultrasound

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Invasive therapeutic methods
2. Ultrasound
Facoemulsifikator
This device is utilised for extraction
of cloudy lense (cataract). Method is
based on low frequency ultrasound
application, which destructs the
cloudy lense, lense is then
emulsificated and sucked off.
3. Electric
Electrotomy and electrocoagulation
extraction of cloudy lense
• use effect of HF electric currents
• production of heat by contact different electrode with tissue
– water is evaporated and cells are destructed. This results in
proteins coagulation and vessels closing – cuts do not bleed

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4. Methods of vital organ support
Invasive therapeutic methods
1. Breathing support – artificial respiration
• is used when no spontaneous respiration is present – apnoe,
or by pulmonary insufficiency – partial presure of oxygen in
arterial blood is < 5kPa, pH<7.25
respiration devices - ventilators
•pressure controled ventilators – switch inspiration
to expiration by chosen pressure value
•volume controled ventilators – possible to set
inspiratory volume, pressure, breathing frequency –
optimal value of pulmonary ventilation
MV =VT
• f

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4. Methods of vital organ support
Invasive therapeutic methods
1. Breathing support – artificial respiration
Parameters whitch can by set on the ventilator:
• respiratory exchange ratio (1:1.5 or 1:2)
• respiratory frequency (8 – 24 /min)
• inspiratory oxygen concentration (20 – 100%)
• inspiratory pressure (maximal value is 7 kPa)
• postinspiration time (between end of inspiration and
start of expiration
-control of PaO2
(by oxymetry) and PaCO2
(by
capnogram)
Special type: CPAP (continuos possitive airway pressure)

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4. Methods of vital organ support
Invasive therapeutic methods
2. Heart function substitution – extracorporeal circulation
Blood pump – elastic tube and rotor with 2
sheaves – they rotate, compress the tube
(not totaly) and drive the blood before them
Amount and pressure of blood is regulated
by turning the pump rotation
Oxygenator – substitutes the lung function,
blood is eliminated from from CO2
and is
saturated by O2
Warmer device – modifies the temperature
of oxygenated blood which returnes to the
body to 37.5 °C

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4. Methods of vital organ support
Invasive therapeutic methods
2. Heart function substitution – extracorporeal circulation

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4. Methods of vital organ support
Invasive therapeutic methods
2. Heart function substitution
artificial
heart
• transplatantion of human´s heart
• implantation of artificial heart – driving
of pump is provided by pressure of
compressed air, suitable noniritable
material is used (imunology)
• surgery substitution of coronary arteries
(bypass) and heart valves (because of
stenosis or insufficiency)
PACEMAKING – uses DC current to
supply failure dischares in „sick sinus
syndrom“ therapy
pacemaker

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4. Methods of vital organ support
Invasive therapeutic methods
3. Artificial kidney - hemodialysis
Basic parts of this device
• Extracorporeal blood circulation - see the previous chapter
• Dialysing circulation – circle which provides flow and preparation
of dialysing solution – by mixing water and NaHCO3.
pH is changed to 7.36 and osmolarity to 5300 mOsm/l (as in blood
plasma). Integrity of dialysing membrane is controled by detection
of hemoglobine amount. Temperature of dialysing solution is kept
on the same value.
treatment of intoxications or disorder of kidney´s function –
filtration, resorbtion

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4. Methods of vital organ support
Invasive therapeutic methods
3. Artificial kidney - hemodialysis
• Dialyser – is divided into 2 parts (blood part and dialysing part) by
dialysing membrane.
Blood flows by laminary streaming (200 – 300 ml/min) on the one
side of the membrane and passes the dialysing membrane, red cells
are located centraly, plasma peripheraly.
Dialysing solution flows in opposit direction by turbulent streaming
(500ml/min) on the other side of the membrane. It results in
increasing of concentration gradient, which leads to rapid diffusion
of low weight molecules – toxic substances (urea, aceton) from
blood to dialysing solution. Velocity of ultrafiltration and amount
of redundant water can be regulated by transmembrane pressure
(middle blood pressure minus pressure of dialysing solution).

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4. Methods of vital organ support
Invasive therapeutic methods
3. Artificial kidney
Peritoneal dialysis – peritoneum works as a filter
– hemoperfusion, hemofiltration (by
intoxication treatment and liver failure)
hemodialysis and peritoneal dialysis - comparison

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4. Methods of vital organ support
Invasive therapeutic methods
4. Artificial lenses
are implanted because of injuries or the cataract
no ability of accomodation
• optic part – increases refractive power of the eye
• haptic part – for mechanical fixation in the eye ball
types:
• solid (polymetacrylate)
• soft (composite
hydrogels, termoplasts)

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4. Methods of vital organ support
Invasive therapeutic methods
5. Cochlear electrode implants
Multiple – electrode stimulating system
consist of 2 parts
External part:
• sound processor
• sensitive microphone amplifier
• transmitter
Internal part:
• receiver implanted under the skin
• electrode system inserted into central
part of cochlea – pars media near to basilar
membrane (beginning of the acustic nerve)
for deaf patients whose conduction of acoustic nerve is intact

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4. Methods of vital organ support
Invasive therapeutic methods
6. Prothesis of limbs
• Mechanical prothesis – mobile only in knee and ankle, enable
walking with assistence (lower extremities) or partial grip function
• Bioprothesis – biosignals conducted by needle electrodes into
preserved muscles. There is a lack feedback reaction between
afferent and efferent signals. Mechanism of unit can be electric,
hydraulic, etc.
• Biomanipulator – bioprothesis of new generation – more
complicated functions are possible
• Endoprothesis – artificial joints made from special steel (knee,
hip joint)

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4. Methods of vital organ support
Invasive therapeutic methods
7. Injection pumps
•enable exact timetable of drug´s application into the circulation
•ensure shift of the injection pump piston in sterile conditions
•speed of dose, quantiy of applied solution, time of application
can be seen on display
•operation of the pump is controled by microprocessor, with
ability to choose the mode
Trombolytic pumps
Drug (which dissolve the thrombus or prevents its formation) is
applied into the vessel by each pulse of compressed air
Insulin pumps
• programmable infusion dosing device
(with thin catheter ended by needle)
• automatic insulin applicator device (plus
automatic control of sugar level in blood)

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Thanks
for
attention
© 2007 Juliana Knocikova